New SGR Replacement Plan Unveiled

Once again, Texans in Congress are playing key roles in fixing our
broken Medicare payment system. The latest joint proposal comes from the House Ways and Means
Committee and Senate Finance Committee. Rep. Kevin Brady chairs the Ways and
Means Committee's Subcommittee on Health, and Sen. John Cornyn sits on the
Senate Finance Committee and its Subcommittee on Health Care.

Another bill, sponsored by Rep. Michael Burgess, MD (R-Texas),
has already passed the House Energy and Commerce Committee with bipartisan
support. TMA will work with all three of them, and the rest of the Texas
delegation to Congress, to come up with the best bill to replace Medicare's
Sustainable Growth Rate (SGR) formula.

TMA leaders will meet with these Texas leaders before, during, and
after the upcoming American Medical Association House of Delegates
meeting.

TMA Webcast Explains Health Insurance Exchanges

A one-hour live webcast, Health Insurance Exchange: Business Impact, at noon CST on
Dec. 5, will help answer many of the questions you probably have about the
health insurance exchanges created by the Affordable Care Act. Lee
Spangler, TMA vice president for medical economics, will examine the details of
the exchanges and what they mean to your practice.

As the December issue
of Texas Medicine will report, you need to figure out if you are
participating in the plan(s) offered in your area and if they will affect your
current payer contracts. You'll need to learn how to identify patients on the
exchange plans and what happens if these patients don't pay their
premiums. The Texas Health and Human Services
Commission estimates 40 percent of the state's 6 million uninsured are eligible
for exchange subsidies. But, only 2,991 Texans successfully picked
a plan during the first month of the exchange's open enrollment period, U.S.
Department of Health and Human Services reported.

You will earn 1 hour of continuing medical education credit by joining
the live webcast.

Delegating and Supervising Prescribing Privileges for APRNs/PAs

With the rules being finalized by the Texas Medical Board, the new law
governing the delegation and supervision of prescribing privileges for advanced
practice registered nurses (APRNs) and physician assistants went into effect
Nov. 1.

The new law — passed as Senate Bill
406 by Sen. Jane Nelson (R-Flower Mound) and Rep. Lois Kolkhorst (R-Brenham)
— replaces the site-based regulatory structure with a more collaborative model
based on periodic quality assurance reviews and a new prescription authority
agreement (PAA).

SB 406 was passed with support from TMA, the Texas Academy of Family
Physicians, the Texas Association of Physician Assistants, and the various
groups representing APRNs. The new law reinforces the importance of
physician-led medical care teams, recognizes the skills all practitioners bring
to patient care, and allows the delegating/supervising physician greater
flexibility in tailoring the PAA to his or her practice.

Medicine Protests Medicare Advantage Terminations

Physicians across the country are being kicked out of Medicare
Advantage (MA) plans, undermining patients' rights and denying them access to
care, TMA, the American Medical Association, and numerous national specialty
societies and state medical associations say in a letter to the Centers for Medicare &
Medicaid Services (CMS).

They asked CMS "to take immediate action" to make sure Medicare
beneficiaries participating in MA plans "have accurate and reliable information
to make health insurance elections during the 2014 Open Enrollment period
…"

The letter says hundreds of physicians hare reported they were
terminated from MA networks. "The terminations are 'without cause' and have been
timed in a manner that undermines the accuracy and reliability of the
information Medicare beneficiaries are relying upon in order to make important
health care decisions for 2014 health insurance coverage. The timing and process
used to communicate the terminations and modifications to the networks are not
consistent with CMS guidance and regulations," the letter says.

They added that the terminations "will disrupt long-established
patient-physician relationships, interfere with existing physician referral
networks, and undermine emergency department coverage in many hospitals. Both
the continuity and coordination of care will be negatively affected, and
treatment for certain types of care commonly provided by a very limited number
of sub-specialists may no longer be available within the network."

TMA and the others urged CMS to extend the MA open enrollment period
and require MA plan sponsors that have reduced their networks to
immediately:

Provide and document that patients received actual and accurate notice of
whether their current physicians will be in the 2014 network;

Ensure that patients know they can retain their physician by choosing
fee-for-service or by choosing a product with an out-of-network benefit if their
plan provides one;

Give physicians information needed to challenge network adequacy based on
CMS regulations and extend the appeals deadline until physicians receive such
information;

Tell AMA and the state medical societies how many patients are impacted and
which physicians were terminated; and

Direct plans to hold all terminations initiated just prior to or during Open
Enrollment in abeyance for 2014.

Help Your Patients Achieve a Healthy Weight

Do you advise your patients to lose weight? If so, check out American Medical
Association Healthier Life Steps® program, which offers hands-on tools to
help patients establish and achieve their goals. You’ll even find tips to start a discussion about weight loss with your
patients.

The Healthier Life Steps program, offered by TMA, provides these practical
resources to help you encourage your patients to exercise, quit smoking, eat
healthier, and reduce risky alcohol use:

Patient lifestyle questionnaires,

Action plans,

Progress-tracking calendars, and

Continuing medical education opportunities.

In addition, the Weigh What Matters app helps patients track their weight,
diet, and exercise — and even calculate their body mass index score — as they
work toward their goals. The app also allows patients to view and email progress
reports to their doctor.

Healthier Life Steps
program materials are free for physicians and patients, courtesy of TMA and
AMA. Physicians can download the materials for use in their practices. For more
information, email the TMA
outreach coordinator or call (800) 888-1300, ext. 1470, or (512)
370-1470.

The Digital Practice: Building a Stronger Online Presence

The latest consumer statistics suggest that more than 90 percent of
potential patients will research your practice online before deciding where to
go for their health care. So what does your online
presence say about your practice?

Is your website properly structured and designed? Do you offer online
appointment scheduling and digital forms? Are you getting good patient reviews
and positive social media talk? Creating and managing a top-notch Internet
presence and positive reputation is imperative to building your practice and
maintaining relationships with current patients.

TMA is offering a new live webinar on Nov. 19
from noon to 1 pm to address these issues and help you evaluate your current
online credibility. This webinar, The Digital Practice: Building a Stronger Online
Presence, is the final installment of the Tech Tuesday series,
which covered a variety of technology topics from HIPAA security to electronic
health record concerns.

Preparing Your EHR for 2014

Physicians participating in the electronic health record (EHR)
incentive program must upgrade their EHR system to the 2014 certified version
before attesting in 2014. Check the Certified Health IT
Product List to see if your vendor has updated the product you use. If
you do not see your EHR listed, you should ask your vendor about its timeline so
that you can adequately prepare and perform testing before going live with the
upgrade product.

Because of the EHR upgrade in 2014, participants of the EHR incentive
program are allowed a 90-day reporting period. Unlike the any-90-day period of
your first year of participation, the 2014 90-day reporting period is by
quarter:

Jan.1 to March 31,

April 1 to June 30,

July 1 to Sept. 30, and

Oct. 1 to Dec. 31.

If 2014 is your first year to report on meaningful use, you may select any
90-day reporting period.

Physicians needing assistance with the EHR incentive program may
receive consulting help from one of four Texas regional extension centers
(RECs). The RECs are qualified to help physicians navigate the complexities of
the program. Check out TMA's REC Resource Center to
find out which REC serves your area.

For more information about EHRs or other health information technology
issues, email TMA's HIT Department or call
(800) 880-5720.

Anson Jones, MD, Awards Honor Physicians

Do you write a medical column for your local newspaper? Host a radio
health show or a weekly medical segment on the local TV news? If so, enter your
work in the TMA Anson Jones, MD,
Awards contest.

For more than 50 years, TMA has honored award-winning Texas journalists with
the Anson Jones, MD, Awards for excellent medical news reporting. TMA opened the
competition to physician-reporters in 2007 with the Physician Excellence in
Reporting category.

This Month in Texas Medicine

The November issue of Texas
Medicinetells you why physicians are glad the legislature
restored funding for women's health but say problems still exist. You'll also
learn about plans for expanding graduate medical education, why TMA is
challenging a CIGNA policy, what physicians say needs to be done about the
state's antiquated mental health hold law, and what state and federal laws say
about communicating with patients.

Texas Medicine RSS Feed

Don't want to wait for Texas Medicine to land in your mailbox? You
can access it as an RSS feed, the
same way you get the TMA Practice E-Tips RSS feed.

E-Tips RSS Feed

TMAPractice E-Tips, a valuable source of hands-on,
use-it-now advice on coding, billing, payment, HIPAA compliance, office policies
and procedures, and practice marketing, is available as an RSS feed on
the TMA
website. Once there, you can download an RSS reader, such as Feedreader,
Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds
for TMA news releases and for Blogged Arteries, the feed for
Action.

This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to Blogged
Arteries.

TMA Deadlines for
Doctors

TMA's Deadlines for
Doctors alerts you and your staff to upcoming state and federal compliance
timelines and offers information on key health policy issues that impact your
practice.

Action, the TMA newsletter, is emailed twice a month to bring you
timely news and information that affects your practice.

To change the email address where you receive Action, go to Member
Log-In on the TMA website, then click on "Update Your TMA Demographic
Information (including newsletter subscriptions and preferences)."

If you have any technical difficulties in reading or receiving this message,
please notify our managing editor, Shari
Henson. Please send any other comments or suggestions you may have about the
newsletter to Larry
BeSaw, Action editor.